Skip to main content
Log in

Varicella-zoster virus encephalitis in a patient undergoing unrelated cord blood transplantation for myelodysplastic syndrome—overt leukemia

  • Case Report
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

Varicella-zoster virus (VZV) infection of the central nervous system (CNS) is rare after hematopoietic stem cell transplantation (SCT). Here, we describe the first patient who developed VZV encephalitis after cord blood transplantation (CBT). A 35-year-old man with myelodysplastic syndrome-overt leukemia underwent CBT. On day +23, a neutrophil count consistently greater than 0.5 X 109/L was achieved. On day +42,1 mg/kg per day of prednisolone therapy was initiated for grade III acute graft-versus-host disease (GVHD). Then, the dose of prednisolone was slowly reduced. For exacerbation of chronic GVHD, the dose of prednisolone was again increased to 1 mg/kg per day on day +231. On day +265, localized cutaneous zoster in the left thoracic region occurred, but soon resolved after acyclovir therapy. On day +309, he suddenly developed diplopia. Subsequently, right facial palsy and hearing impairment occurred. No skin rash was observed. Magnetic resonance imaging (MRI) scans revealed multifocal abnormal high-signal intensity in the CNS. A high level of VZV DNA was detected in a cerebrospinal fluid specimen. He was diagnosed with VZV encephalitis. Acyclovir was given intravenously for 40 days. Four months after the onset, the neurologic symptoms had incompletely resolved. MRI scans showed substantial resolution but with mild residual lesions. The present report indicates that VZV should be considered as a possible causative agent in patients who develop multifocal neurologic symptoms of the CNS after SCT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Locksley RM, Flournoy N, Sullivan KM, Meyers JD. Infection with varicella-zoster virus after marrow transplantation. J Infect Dis. 1985;152:1172–1181.

    Article  CAS  PubMed  Google Scholar 

  2. Han CS, Miller W, Haake R, Weisdorf D. Varicella zoster infection after bone marrow transplantation: incidence, risk factors and complications. Bone Marrow Transplant. 1994;13:277–283.

    CAS  PubMed  Google Scholar 

  3. Koc Y, Miller KB, Schenkein DP, et al. Varicella zoster virus infections following allogeneic bone marrow transplantation: frequency, risk factors, and clinical outcome. Biol Blood Marrow Transplant. 2000;6:44–49.

    Article  CAS  PubMed  Google Scholar 

  4. Tauro S, Toh V, Osman H, Mahendra P. Varicella zoster meningoencephalitis following treatment for dermatomal zoster in an alloBMT patient. Bone Marrow Transplant. 2000;26:795–796.

    Article  CAS  PubMed  Google Scholar 

  5. Tenenbaum T, Kramm CM, Laws HJ, Nurnberger W, Lenard HG, Gobel U. Pre-eruptive varicella zoster virus encephalitis in two children after haematopoietic stem cell transplantation. Med Pediatr Oncol. 2002;38:288–289.

    Article  PubMed  Google Scholar 

  6. Hackanson B, Zeiser R, Bley TA, et al. Fatal varicella zoster virus encephalitis in two patients following allogeneic hematopoietic stem cell transplantation. Clin Transplant. 2005;19:566–570.

    Article  PubMed  Google Scholar 

  7. Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ. Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med. 2000;342:635–645.

    Article  CAS  PubMed  Google Scholar 

  8. Kleinschmidt-DeMasters BK, Gilden DH. Varicella-zoster virus infections of the nervous system: clinical and pathologic correlates. Arch Pathol Lab Med. 2001;125:770–780.

    Google Scholar 

  9. Gilden D. Varicella zoster virus and central nervous system syndromes. Herpes. 2004;11(suppl 2):89A-94A.

    PubMed  Google Scholar 

  10. Tomonari A, Iseki T, Takahashi S, et al. Varicella-zoster virus infection in adult patients after unrelated cord blood transplantation: a single institute experience in Japan. Br J Haematol. 2003;122:802–805.

    Article  PubMed  Google Scholar 

  11. Takahashi S, Iseki T, Ooi J, et al. Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies. Blood. 2004;104:3813–3820.

    Article  CAS  PubMed  Google Scholar 

  12. Kronenberg A, Schupbach R, Schuknecht B, et al. Multifocal vasculopathy due to varicella-zoster virus (VZV): serial analysis of VZV DNA and intrathecal synthesis of VZV antibody in cerebrospinal fluid. Clin Infect Dis. 2002;35:330–333.

    Article  PubMed  Google Scholar 

  13. De La Blanchardiere A, Rozenberg F, Caumes E, et al. Neurological complications of varicella-zoster virus infection in adults with human immunodeficiency virus infection. Scand J Infect Dis. 2000;32:263–269.

    Article  Google Scholar 

  14. Tomonari A, Iseki T, Ooi J, et al. Cytomegalovirus infection following unrelated cord blood transplantation for adult patients: a single institute experience in Japan. Br J Haemtol. 2003;121:304–311.

    Article  Google Scholar 

  15. Tomonari A, Takahashi S, Ooi J, et al. Human herpesvirus 6 variant B infection in adult patients after unrelated cord blood transplantation. Int J Hematol. 2005;81:352–355.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Akira Tomonari.

About this article

Cite this article

Fukuno, K., Tomonari, A., Takahashi, S. et al. Varicella-zoster virus encephalitis in a patient undergoing unrelated cord blood transplantation for myelodysplastic syndrome—overt leukemia. Int J Hematol 84, 79–82 (2006). https://doi.org/10.1532/IJH97.06044

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1532/IJH97.06044

Key words

Navigation